PANCE/PANRE Practice Exam Questions
and Correct Answers (Verified Answers)
Plus Rationale 2027 Q&A| Instant
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1. A 58-year-old man presents with substernal chest pressure that
began 30 minutes ago while mowing his lawn. The pain radiates
to his left arm and is associated with diaphoresis and nausea. ECG
demonstrates ST-segment elevations in leads II, III, and aVF.
Which coronary artery is most likely occluded?
a. Left anterior descending artery
b. Left circumflex artery
c. Right coronary artery
d. Left main coronary artery
Rationale: ST-segment elevations in leads II, III, and aVF indicate an
inferior myocardial infarction. The right coronary artery most
commonly supplies the inferior wall of the left ventricle. Inferior
,infarctions may also involve the right ventricle and the AV node,
making hypotension and bradyarrhythmias important complications.
2. A 24-year-old woman presents with fatigue, weight loss, heat
intolerance, tremor, and palpitations. Examination reveals a
diffusely enlarged thyroid and bilateral exophthalmos. Which
laboratory pattern is most consistent with her condition?
a. Increased TSH and decreased free T4
b. Increased TSH and increased free T4
c. Decreased TSH and decreased free T4
d. Decreased TSH and increased free T4
Rationale: The patient has classic Graves disease, an autoimmune
cause of primary hyperthyroidism. Excess thyroid hormone suppresses
pituitary TSH secretion through negative feedback, producing low TSH
with elevated free T4 and/or T3. Diffuse goiter and ophthalmopathy
are characteristic of Graves disease.
3. A 67-year-old woman develops sudden right-sided weakness and
expressive aphasia. CT of the head shows no hemorrhage. Which
artery is most likely involved?
a. Right middle cerebral artery
b. Left middle cerebral artery
,c. Left posterior cerebral artery
d. Right anterior cerebral artery
Rationale: The left cerebral hemisphere is usually dominant for
language. The middle cerebral artery supplies the lateral frontal and
parietal lobes, including the motor cortex controlling the face and
upper extremity and Broca area. Therefore, a left MCA stroke can
produce right-sided weakness and expressive aphasia.
4. A 32-year-old woman presents with dysuria, urinary frequency,
and suprapubic discomfort. She has no fever, flank pain, or vaginal
symptoms. Urinalysis shows pyuria and positive leukocyte
esterase. Which diagnosis is most likely?
a. Acute pyelonephritis
b. Nephrolithiasis
c. Acute uncomplicated cystitis
d. Vaginitis
Rationale: Dysuria, frequency, and suprapubic discomfort without
systemic illness or flank pain are typical of acute cystitis. Pyuria and
leukocyte esterase support a urinary tract infection. Pyelonephritis
would generally cause fever, flank pain, and costovertebral-angle
tenderness.
, 5. A 72-year-old man with chronic obstructive pulmonary disease
presents with worsening dyspnea and increased sputum
production. His sputum has become purulent. Which finding most
strongly supports an acute COPD exacerbation?
a. Isolated chronic cough
b. Stable exercise intolerance
c. Increased dyspnea, sputum volume, and sputum purulence
d. Mild expiratory wheezing unchanged from baseline
Rationale: Acute COPD exacerbations are characterized by worsening
respiratory symptoms, particularly increased dyspnea, sputum
volume, and sputum purulence. These changes represent an acute
deterioration beyond the patient's usual day-to-day symptoms.
6. A 19-year-old college student presents with fever, headache, neck
stiffness, and photophobia. Lumbar puncture demonstrates
elevated opening pressure, neutrophilic pleocytosis, elevated
protein, and decreased glucose. Which organism is a common
cause of bacterial meningitis in this age group?
a. Escherichia coli
b. Listeria monocytogenes
c. Neisseria meningitidis
d. Cryptococcus neoformans
and Correct Answers (Verified Answers)
Plus Rationale 2027 Q&A| Instant
Download Pdf
1. A 58-year-old man presents with substernal chest pressure that
began 30 minutes ago while mowing his lawn. The pain radiates
to his left arm and is associated with diaphoresis and nausea. ECG
demonstrates ST-segment elevations in leads II, III, and aVF.
Which coronary artery is most likely occluded?
a. Left anterior descending artery
b. Left circumflex artery
c. Right coronary artery
d. Left main coronary artery
Rationale: ST-segment elevations in leads II, III, and aVF indicate an
inferior myocardial infarction. The right coronary artery most
commonly supplies the inferior wall of the left ventricle. Inferior
,infarctions may also involve the right ventricle and the AV node,
making hypotension and bradyarrhythmias important complications.
2. A 24-year-old woman presents with fatigue, weight loss, heat
intolerance, tremor, and palpitations. Examination reveals a
diffusely enlarged thyroid and bilateral exophthalmos. Which
laboratory pattern is most consistent with her condition?
a. Increased TSH and decreased free T4
b. Increased TSH and increased free T4
c. Decreased TSH and decreased free T4
d. Decreased TSH and increased free T4
Rationale: The patient has classic Graves disease, an autoimmune
cause of primary hyperthyroidism. Excess thyroid hormone suppresses
pituitary TSH secretion through negative feedback, producing low TSH
with elevated free T4 and/or T3. Diffuse goiter and ophthalmopathy
are characteristic of Graves disease.
3. A 67-year-old woman develops sudden right-sided weakness and
expressive aphasia. CT of the head shows no hemorrhage. Which
artery is most likely involved?
a. Right middle cerebral artery
b. Left middle cerebral artery
,c. Left posterior cerebral artery
d. Right anterior cerebral artery
Rationale: The left cerebral hemisphere is usually dominant for
language. The middle cerebral artery supplies the lateral frontal and
parietal lobes, including the motor cortex controlling the face and
upper extremity and Broca area. Therefore, a left MCA stroke can
produce right-sided weakness and expressive aphasia.
4. A 32-year-old woman presents with dysuria, urinary frequency,
and suprapubic discomfort. She has no fever, flank pain, or vaginal
symptoms. Urinalysis shows pyuria and positive leukocyte
esterase. Which diagnosis is most likely?
a. Acute pyelonephritis
b. Nephrolithiasis
c. Acute uncomplicated cystitis
d. Vaginitis
Rationale: Dysuria, frequency, and suprapubic discomfort without
systemic illness or flank pain are typical of acute cystitis. Pyuria and
leukocyte esterase support a urinary tract infection. Pyelonephritis
would generally cause fever, flank pain, and costovertebral-angle
tenderness.
, 5. A 72-year-old man with chronic obstructive pulmonary disease
presents with worsening dyspnea and increased sputum
production. His sputum has become purulent. Which finding most
strongly supports an acute COPD exacerbation?
a. Isolated chronic cough
b. Stable exercise intolerance
c. Increased dyspnea, sputum volume, and sputum purulence
d. Mild expiratory wheezing unchanged from baseline
Rationale: Acute COPD exacerbations are characterized by worsening
respiratory symptoms, particularly increased dyspnea, sputum
volume, and sputum purulence. These changes represent an acute
deterioration beyond the patient's usual day-to-day symptoms.
6. A 19-year-old college student presents with fever, headache, neck
stiffness, and photophobia. Lumbar puncture demonstrates
elevated opening pressure, neutrophilic pleocytosis, elevated
protein, and decreased glucose. Which organism is a common
cause of bacterial meningitis in this age group?
a. Escherichia coli
b. Listeria monocytogenes
c. Neisseria meningitidis
d. Cryptococcus neoformans
